Digital Health in a Time of Transformation: Technology Changes Everything

Patients are eager, and physicians are willing to embrace digital medicine. Digital is unquestionably part of the future of medicine. The question is who will seize the opportunity?

The ways we live, work, and play continually changes, often driven by transformations in technology. You used to have to go to the bank and line up to talk to a teller to get money or deposit a paper check. And you had to do it during very restricted banking hours. Then came ATMs, followed by online banking and digital wallets. Now, some banks don’t even have physical branches.

However, our interactions with doctors and other healthcare professionals have changed relatively little over the past centuries. Other than the odd phone call, the vast majority of doctor-patient interactions continue to be old fashioned, face-to-face meetings.

Hospitals and payors are desperate to find ways to cut costs. Patients, meanwhile, are not pleased by having to trek to the doctor and sit squirming in crowded waiting rooms reading old, well-thumbed magazines. Doctors, under constant time pressures, would like to find more efficient ways of working while keeping their patients satisfied. There is pressure for change.

In this post, we report on the perspectives of both patients and physicians, identifying who will happily change, and who will resist a movement to digital healthcare. We examine the drivers and barriers to accepting the role of technology in medicine and look at the current early adoption of digital medicine. Finally, we suggest paths to innovation in digital medicine, and important considerations in developing cost-saving offers that people will embrace.

——————————————————————————————————————————————We leveraged our National Panel, Springboard America, and surveyed 1,300 U.S. patients to start. We then partnered with SurveyHealthcare, a leading healthcare professional market research recruitment agency, to survey 110 General Practice physicians (mix of office and hospital affiliations) to capture opinions of both sides of the spectrum. We also shared patient survey data back with physicians to understand physician reactions to the patient data.——————————————————————————————————————————————

Reacting to a real-world model of digital medicine

Digital medicine is a vague concept that has no consistent meaning for most patients and physicians. To get realistic reactions to the idea, we exposed both patients and physicians to a description of a model recently launched by New York Presbyterian Hospital. The model has five elements, and we probed interest in each one.

Patients are eager, and physicians are willing

Overall, two thirds of patients (69%) and physicians (65%) are interested in one or more aspects of this digital medicine offer. The remarkable similarities between these numbers suggest that patients who want to access digital services will be able to find providers. Likewise, for those who want continue to go the old-school route.

It is worth noting, however, that once exposed to our patient research findings, many physicians were surprised by the level of patient interest in the digital health services, anticipating far less enthusiasm.

Interest was notably higher among millennial patients who have grown up always knowing the internet. And interest was definitely softer amongst the baby boomers, whose first exposure to anything digital was probably a mainframe computer using punch cards.

These kinds of age-driven differences are not unique to medicine. They are driven by the differences between digital natives and those who came to use computers later in life.

Physicians affiliated with a hospital are more likely to be interested than those who are strictly office-based (78% vs. 56%), but that is likely due—at least in part—to the hospital-based nature of this particular offer.

Consensus on consults

When we zeroed in on specific aspects of the offer, we saw the highest levels of interest in the more standard office-based consults, such as virtual visits, second opinions, and what New York Presbyterian Hospital calls urgent care. Both doctors and patients were most interested in these offers.

Currently, however, just 7% of patients have used Skype or some other form of video conferencing to consult with a physician, and fewer than a fifth of physicians have offered it as an option to their patients. So, while there is widespread interest, there is very little actual experience.

The potential popularity of this kind of technology-mediated consultation is not surprising given its long history, particularly in remote areas. Almost a century ago, pedal-powered radios allowed physicians to diagnose, monitor, and provide instructions for the care of patients in remote parts of Australia and, later, around the world. Much has changed since then, but the basics of remote consultations remain the same.

Differences that divide

There is a notable difference between patients and physicians on the inter-hospital consult offer, but it is driven by the lack of interest amongst office-based physicians (36%). The other big difference between physicians and patients was on emergency care.

Although fewer patients were sold on the idea of computer-mediated emergency care, far fewer doctors were comfortable with it. Physicians were more likely to feel the quality of care will be inferior to traditional in-person health services. However, this concern is less pronounced among physicians practicing in a hospital vs. an exclusively office-based setting- 28% vs. 45%, respectively. A common concern for physicians was missing something in an emergency situation. “MDs need to use all of their capable senses to adequately evaluate a patient,” a physician explained. That’s not to say that digital medicine does not have a role in emergency medicine. Indeed, it has a large and important one in many aspects—including portable monitoring and diagnostic tools. It’s just that in these circumstances, more physicians have misgivings about missing something.

“The main limitations today says, Kari Gali, a pediatric nurse-practitioner for the Cleveland Clinic who takes such video calls, are that she cannot look into children’s ears or listen to their chests. As these and more sophisticated diagnostics, including blood tests and virtual imaging, become available remotely, more hospital patients could receive care without leaving home. Gupta Strategists, a Dutch research company, reckons around 45% of care now given in Dutch hospitals could be done better at home.”
-Prescription for the future, The Economist, April 8, 2017

Elements that entice

Patient interest in digital health offers is all about convenience and efficiency. And, after years of waiting in drab and dire waiting rooms, who can blame them?

Patients also hope for cost effectiveness and access to a wider array of physicians who can provide additional insights.

“Cutting edge care” doesn’t cut it, and the potentially enormous benefits of increased compliance is something they just don’t comprehend.

For patients, the enticing element of this digital health offer is convenience. It is not about better care, it is about getting the same care, only more conveniently. It’s a practice they see as “patient centric.”

Elements that entice patients

Physicians share their patients’ hopes. They understand this new digital approach is about patient convenience.

The reality is that this new model does not offer much convenience to physicians. They already have patients lined up waiting to be seen. That’s quite efficient for them, just like it used to be more efficient for banks to have people waiting for their tellers.

But physicians do see the writing on the wall. Most of them—particularly the younger ones—understand that times have changed, and that they must too.

They hope it will encourage empowerment, maybe save patients money, and give them access to other perspectives too. Physicians also agree with patients that increased compliance and being “cutting edge” are potential benefits that don’t carry any weight in the decision to go digital. They get that, this time, it’s all about the patients.

Elements that entice physicians

Factors that are fences

Those patients who were not interested in this digital health offer were primarily concerned about the potential cost, and physicians empathize. “Insurance companies must recognize this form of treatment,” noted one physician. Privacy, and, to a lesser degree, the unproven quality of care are also concerns.

Physicians who were not interested in offering this particular package of digital medical services were primarily concerned about a reduction in the quality of care. Concerns about privacy of medical information and being reimbursed were also barriers to use.

Factors that fence out patients

Concerns about a reduced quality of care will inevitably stir up worries about being sued for malpractice. According to surgeon Atul Gawande, “The average doctor in a high-risk practice like surgery or obstetrics is sued about once every six years. Seventy percent of the time, the suit is either dropped by the plaintiff or won by the doctor in court. But the cost of defense is high, and when doctors lose, the average jury verdict is half a million dollars. General surgeons pay anywhere from thirty thousand to three hundred thousand dollars a year in malpractice-insurance premiums, depending on the litigation climate of the state they work in; neurosurgeons and obstetricians pay upward of 50 percent more.”(1)

When you need to pay hundreds of thousands of dollars a year to insure against claims of malpractice, it makes sense that some would be hyper-sensitive to concerns about moving to a digital approach (or probably any change that would excite concerns about reduction in the quality of care).

Anecdotally, some physicians indicate a desire for pilot studies demonstrating the effectiveness of digital medicine: “Demonstrate efficacy with data.”

Factors that fence out physicians

“Digital disruption and transformation within the healthcare profession is a Hard Trend — something that will happen, something we can count on seeing in the future…. More and more, patients across the US and the world are taking charge of their own healthcare, and hospitals, pharmacies, insurance companies, and medical professionals, are finding themselves forced to adapt to this new wave of digital disruption or face losing patients and falling behind their competitors.”
–Daniel Burrus, Futurist & Innovation Expert

Finding the winning offer

In reactions to this digital medicine offer, we see widespread interest on the part of both patients and physicians. This suggests tremendous opportunity to increase share, and enhance profitability by offering digital medical experiences that will heighten patient satisfaction and generate operational efficiencies.

But, we also see that there are some things—like emergency care—that patients might be open to, but that physicians might prefer to avoid. This underscores the importance of understanding the perspective of all stakeholders. An offer that falls down with any stakeholder will not fly.

This indicates a need to quickly and efficiently generate, test, refine and optimize digital medicine offers. There are many fruitful ways forward.

Innovation opportunity

All stakeholder groups are potential sources of ideas. Communities of each allow you to quickly and iteratively develop and test ideas. Each stakeholder brings their unique and essential perspective.

Co-creation is a great way to tap into the needs patients have, as well as the opportunities employees identify. A “jobs to be done” approach identifying patient and physician needs is also often a fruitful source of innovation ideas.(2) Likewise, presenting patients with elements of an offer and asking them to “build your own” reveals much about which features have widespread appeal, and which ones fail to encourage enthusiasm.

Fail early, fail fast

To obtain more gold, you must sift through more ore. To find great digital medical offers you need to generate a lot of ideas, quickly and efficiently filter through them, and grab the nuggets that require further refinement. That’s why we developed Idea Filter, a tool that allows you to have a stakeholder review an idea in a minute or less. Patients can be the first filter, followed by physicians and the other healthcare providers that have to deliver on these services. After these two stages, many clients have benefited from running the most appealing ideas past employees, to obtain their seasoned judgment and operational expertise.

Optimizing offers

Optimization could take the form of A/B testing alternative expressions of an offer, or simple choice models. In cases where there is a need to prioritize, total unduplicated research (TUR) analysis can reveal which combination of messages have the biggest impact with the most people. When it comes to deciding how to communicate a feature, our Message Filter tool provides the same kind of ultra-quick and sensitive analysis to help you identify an optimal expression.

Digital disruption is coming. Are you ready?

“Bold, tightly integrated digital strategies will be the biggest differentiator between companies that win and companies that don’t, and the biggest payouts will go to those that initiate digital disruptions,” says McKinsey, a global management consultancy firm.(3)

Now is the time to consider how your organization can harness the digital disruption that will be coming to the doctor-patient relationship. In an atmosphere of untapped interest and willingness to adapt, there are incredible opportunities to enhance services and increase profitability.

The challenge lies before us. Let’s embrace it and win!

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Better: A Surgeon’s Notes on Performance Atul Gawande, Metropolitan Books, New York 2008

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